尿毒症心衰患者非常规体位时超声引导下深静脉置管的安全性分析  

Safety of ultrasound-guided deep vein catheterization in uremic patients with heart failure under unconventional body positions: report of 148 cases

作　　者：卓燕[1] 袁茜[1] 谢攀[1] 李绍华[1] 明静[2] 朱俊萍[2] 孙岩[1] 

机构地区：[1]第三军医大学西南医院肾科,重庆400038 [2]第三军医大学西南医院超声科,重庆400038

出　　处：《第三军医大学学报》2016年第16期1881-1884,共4页Journal of Third Military Medical University

摘　　要：目的探讨尿毒症心衰患者非常规体位时超声引导下深静脉置管的安全性及有效性。方法回顾性分析2012年12月至2015年12月西南医院肾科148例尿毒症心衰患者病例（男性77例,女性71例,年龄25～67岁,平均45.2岁）,比较、分析其在超声引导下深静脉置管成功率,穿刺时体位,穿刺时间,穿刺部位及相关并发症。结果 148例患者半卧位置管89.2%,端坐位置管10.8%,超声引导下深静脉置管成功率为100%,一次穿刺成功率为90.5%,穿刺时间6～20 min,穿刺并发症1.4%。颈内静脉置管84.5%,股静脉置管15.5%。颈内静脉置管感染、血栓及血流量不足发生率低于股静脉置管者（P〈0.05）。结论超声引导下深静脉置管可突破尿毒症心衰患者在置管时对穿刺体位的局限,提高其在非常规体位时颈内静脉置管成功率,减少并发症。Objective To determine the safety and effectiveness of ultrasound-guided deep vein catheterization in the uremic patients with heart failure under unconventional body positions. Methods A retrospective analysis was conducted on 148 uremic patients with heart failure admitted in our department between December 2012 and December 2015. They were 77 males and 71 females,and at a mean age of 45. 2（ ranging from 25 to 67）. The successful rate of ultrasound-guided deep vein catheterization,body positions at puncture,puncture duration,puncture sites and related complications were observed and analyzed. Result Among the 148 patients,89. 2% patients received catheterization under semireclining position,and 10. 8%under sitting position. The successful rate of the catheterization was 100%,with one-time procedure of90. 5%,and puncture duration ranging from 6 to 20 min. The puncture complications occurred in 1. 4%patients. For the subjects,84. 5% received catheterization in the internal jugular vein and 15. 5% in the femoral vein. The incidences of infection,thrombus and insufficient blood flow were significantly lower in the internal jugular vein catheterization than the femoral vein catheter（ P 〈0. 05）. Conclusion Ultrasoundguided deep vein catheterization can break the limits of the puncture position of uremia patients with chronic heart failure,enhance the successful rate of internal jugular vein catheterization under unconventional body positions,and reduce the incidence of complications.

关 键 词：超声引导 深静脉置管 尿毒症 心衰 

分 类 号：R445.1[医药卫生—影像医学与核医学] R459.5[医药卫生—诊断学]